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CLIENT ALERT: Medicare Trust Fund to Run Out of Funding Beginning in 2026, Likely to See an Increase in Audits, Overpayment Demands and Extrapolations

Client Alert
June 6, 2018

Pursuant to a Medicare Trustee Report released on June 5, 2018, the Medicare trust fund will run out of funding beginning in 2026, which is three years earlier than previously expected.  Although the Trustee’s report requests that Congress and the President act with urgency to remedy this problem, in the short term, we expect to see an increase in government payer audits, overpayment demands, and extrapolations.

 

If implemented in full strength, these overpayment demands and extrapolations can result in payers recovering millions of dollars from providers, which may be returned to the trust fund.  In the alternative, payers and their contractors may allege overpayments so that providers agree to a settlement requesting the provider to accept pennies on the dollar for the true amount owed to the provider.

 

Either way, it is now more crucial than ever before that providers take action when government payers and their contractors seek to conduct pre- and post-payment audits and otherwise seek the refund of overpayments.

 

BMD’s Healthcare Department can meet with you to discuss your options if your practice is facing pre- and/or post-payment audits and denials.  If you are subjected to an overpayment, including an extrapolation, our experienced team can strategize your appeal and arguments for success in challenging the overpayment allegations.

 

If you have any questions concerning payer audits, appeals, overpayments, and extrapolations, or the administrative appeal process in general, please contact  Amanda L. Waesch, Esq. (alwaesch@bmdllc.com) or Bryan E. Meek, Esq. (bmeek@bmdllc.com), attorneys in Brennan, Manna & Diamond’s Provider Relations, Audits, Appeals, and Negotiations Unit, a division of BMD’s Healthcare Department.

 

Health LawHealthcareMedicare;
Client Alert

Florida's Recent Ruling on Arbitration Clauses

March 15, 2024Florida’s recent ruling on arbitration clauses provides a crucial distinction in determining whether such clauses are void as against public policy and providers may have the opportunity to include arbitration clauses in their patient consent forms. On March 6, 2024, Florida’s Fourth District Court of Appeals reversed and remanded Florida’s Fifteenth Circuit Court ruling of Piero Palacios v. Sharnice Lawson. The Court of Appeals ruled that the parties’ arbitration agreement did not contradict the Legislature’s intent of Florida’s Medical Malpractice Act (the “MMA”), but rather reflects the parties’ choice to arbitrate claims entirely outside of the MMA’s framework. Therefore, the Court found that the agreement was not void as against public policy.Client Alert

Corporate Transparency Act Update 3/14/24

March 14, 2024On March 1, 2024, a federal district court in the Northern District of Alabama concluded that the Corporate Transparency Act (“CTA”) exceeded Congressional powers and enjoined the Department of the Treasury from enforcing the CTA against the plaintiffs. National Small Business United v. Yellen, No. 5:22-cv-01448 (N.D. Ala.). On March 11, 2024, the U.S. Department of Justice appealed the district court’s decision to the Eleventh Circuit Court of Appeals.Client Alert

The Ohio State University Launches Its Accelerated Bachelor of Science in Nursing Program

February 27, 2024In response to Ohio’s nursing shortage, The Ohio State University College of Nursing is accepting applications for its new Accelerated Bachelor of Science in Nursing program (aBSN). Created for students with a bachelor’s degree in non-nursing fields, the aBSN allows such students to obtain their nursing degree within 18 months. All aBSN students will participate in high-quality coursework and gain valuable clinical experience. Upon completion of the program, graduates will be eligible to take the State Board, National Council of Licensure Exam for Registered Nursing (NCLEX-RN).Client Alert

Another Transparency Obligation: The FinCEN Beneficial Ownership Information Reporting Requirements

February 26, 2024Many physician practices and healthcare businesses are facing a new set of federal transparency requirements that require action now. The U.S. Department of Treasury Financial Crimes Enforcement Network (“FinCEN”) Beneficial Ownership Information Reporting Requirements (the “Rule”), which was promulgated pursuant to the 2021 bipartisan Corporate Transparency Act, is intended to help curb illegal finance and other impermissible activity in the United States.Client Alert

“In for a Penny, in for a Pound” is No Longer the Case for Florida Lawyers

February 19, 2024On April 1, 2024, newly adopted Rule 1.041 to the Florida Rules of Civil Procedures goes into effect which creates a procedure for an attorney to appear in a limited manner in civil proceedings.  Currently, when a Florida attorney appears in a civil proceeding, he or she is reasonable for handling all aspects of the case for their client.  This new rule authorizes an attorney to file a notice limiting the attorney’s appearance to particular proceedings or specified matters prior to any appearance before the court.  For example, an attorney can now appear for the limited purpose of filing and arguing a motion to dismiss.  Once the motion to dismiss is heard by the court, the attorney may file a notice of termination of limited appearance and will have no further obligations in the case.
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